الفهرس 
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Abstract
Introduction: Diabetes mellitus is a common condition which is becoming even more common with the passage of time. The complications of diabetes are numerous and include the musculoskeletal disorders that have been generally ignored and poorly treated compared with other complications. Most of these disorders seem to be associated with the duration of DM. In fact, although these disorders are not life-threatening, it may severely impair the daily activities and the quality of life of the diabetic patients. The most common musculoskeletal disorders in diabetic patients include: disorders involving the soft tissue such as limited joint mobility syndrome, trigger finger, adhesive shoulder capsulitis, calcific shoulder periarthritis, diffuse idiopathic skeletal hyperostosis; disorders linked to neuropathy such as carpal tunnel syndrome; disorders involving joints such as Charcot osteoarthropathy; and finally disorders involving bone such as osteoporosis and bone fractures. The exact pathophysiology of most of these musculoskeletal disorders remains obscure. It may be due to direct consequences of persistant hyperglycaemia that act through several mechanisms, for example it can stimulate the non-enzymatic glycosylation resulting in the formation of AGEs. Consequences of diabetic complications such as vascular insufficiency, and neuropathy play an important role. Other changes occurring in DM is also important e.g., insulin and insulin-like growth factor deficiency that seen in type 1diabetes and hyperinsulinaemia associated with type 2 diabetes. Diagnosis of these disorders depends mainly on clinical presentation and physical examination of the patient beside various diagnostic methods that can be utilized depending on the type of affection. Recognition of the association between diabetes mellitus and musculoskeletal disorders facilitates their correct diagnosis and prompt initiation of appropriate treatment. Moreover, awareness and identification of the characteristic musculoskeletal manifestations of diabetes may facilitate earlier diagnosis of diabetes mellitus and initiation of glucose-lowering therapy to retard the development of diabetic complications. Treatment of these disorders depends mainly on tight glycaemic control plus physiotherapy, pain management, corticosteroids injection, and in rare cases, surgical interference may be needed. It should be noted that corticosteroids when indicated, should be given with caution in diabetic patients to avoid disturbing glycaemic/ metabolic homeostasis. Caution should be also taken when using the nonsteroidal anti-inflammatory drugs in such patients as they may diminish the renal blood flow and exacerbate renal insufficiency.
Conclusions: Diabetes mellitus commonly affect the musculoskeletal system causing a variety of disorders. These disorders may go unrecognized or simply overlooked in daily clinical practice despite they are a major cause of deformities and disabilities. Thus, it is essential to recognize and diagnose these disorders as most of them are treatable (to varying degrees) with marked improvement in quality of life and more independence in activities of daily living of diabetic patients.